医院差异化护理实践的探索：新护理角色实践的学习历程
Working on differentiated nursing practices in hospitals: A learning history on enacting new nursing roles.
作者信息
Martini Dieke, Schalkwijk Hugo, Schoonhoven Lisette, Noordegraaf Mirko, Lalleman Pieterbas
机构信息
Research Group for Person-Centeredness in an Ageing Society, Fontys University of Applied Sciences, Eindhoven, The Netherlands.
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
出版信息
J Adv Nurs. 2025 Jan;81(1):439-449. doi: 10.1111/jan.16240. Epub 2024 May 29.
OBJECTIVE
This study aims to better understand how new future-oriented nursing roles are enacted in a general hospital.
DESIGN
A learning history, that is, a participatory action-oriented research design to explore and foster organizational learning.
METHODS
Data collection consisted of a (historical) document analysis, the shadowing of differentiated nursing practices (36 h), 22 open interviews, 4 oral history interviews, 2 focus groups and a podcast series (7 h) created with participants.
RESULTS
The data gathered revealed three important themes regarding enacting new nursing roles: (1) stretching the nature of nursing work, (2) using earlier experiences and (3) collectively tackling taboos.
CONCLUSIONS
Differentiated nursing practices and enacting new nursing roles have long and complex histories. Attempts to differentiate are often met with resistance from within the nursing profession. This study shows how the new role of nurse coordinator was negotiated in nursing teams. With a bottom-up approach focused on collective responsibilities. By acknowledging and reflecting on the past, spaces were enacted in which the role of nurse coordinator became one role, among others, in the delivery of patient care.
IMPACT
This study provides an innovative perspective on differentiated nursing practices by focusing on the past, the present and the future. We found that local, situated conditions can be taken as starting points when new nursing roles are enacted. In addition, shifting focus from individual nursing roles to nursing team development, emphasizing collective responsibilities, softens strong (historically) grown emotions and creates spaces in which new roles become negotiable.
PATIENT OR PUBLIC CONTRIBUTION
No patient or public contribution.
目的
本研究旨在更好地了解综合医院中面向未来的新护理角色是如何得以实施的。
设计
采用学习历程法，即一种以参与式行动为导向的研究设计，以探索和促进组织学习。
方法
数据收集包括（历史）文献分析、不同护理实践的跟踪观察（36小时）、22次开放式访谈、4次口述历史访谈、2次焦点小组讨论以及与参与者共同制作的一系列播客（7小时）。
结果
收集到的数据揭示了有关实施新护理角色的三个重要主题：（1）拓展护理工作的性质；（2）借鉴早期经验；（3）共同应对禁忌。
结论
不同的护理实践和新护理角色的实施有着漫长而复杂的历史。差异化的尝试往往遭到护理行业内部的抵制。本研究展示了护士协调员的新角色在护理团队中是如何通过自下而上、注重集体责任的方式进行协商的。通过承认和反思过去，创造了一些空间，在这些空间里，护士协调员的角色成为了提供患者护理过程中的众多角色之一。
影响
本研究通过关注过去、现在和未来，为不同护理实践提供了一个创新视角。我们发现，在实施新护理角色时，可以将当地的实际情况作为出发点。此外，将重点从个体护理角色转向护理团队发展，强调集体责任，能够缓解（历史上）长期形成的强烈情绪，并创造出有利于新角色协商的空间。
患者或公众贡献
无患者或公众参与。
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